| NPI | 1356550131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 50740) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: HI 13772) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO 47729) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2009-07-21 |