| NPI | 1447394903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 49624) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 18562) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2012-00314) | |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2012-10-30 |