| NPI | 1336106475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 076870) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007657) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2018-06-14 |