| NPI | 1407857956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME38699) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AL 8347) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2019-03-25 |