| NPI | 1265588248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: DC 9522) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MD D0046298) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2008-04-09 |