| NPI | 1477539989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 76166) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MA 76166) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2013-08-30 |