| NPI | 1295952364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX D3364) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: TX D3364) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2008-03-24 |