| NPI | 1225118359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 2368) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS004221-L) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 701) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |