| NPI | 1396961850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X (Licence: TX D1678) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX D1678) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-08 |