| NPI | 1407052228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 20658) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 658-L) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2013-08-16 |