| NPI | 1336551738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301105142) |
| Additional Taxonomies | 1835P1300X Pharmacist Psychiatric (Licence: MI 5315065056) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |