| NPI | 1306992086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 46543) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 46543) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2014-07-30 |