NPI | 1255481024 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX m2935) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101236508) |
Enumeration Date | 2007-01-11 |
Last Update Date | 2007-07-08 |