| NPI | 1316057011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102201392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201392) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-08-05 |