| NPI | 1467546457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 28945) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-05-29 |