| NPI | 1255495792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301089616) |
| Additional Taxonomies | 175L00000X Homeopath (Licence: NY 197802) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2012-12-21 |