| NPI | 1457316515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2004014263) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KS 0430478) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-07-08 |