| NPI | 1265655948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SD 8455) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WV 24007) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2013-12-05 |