| 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 |