| NPI | 1477547370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-9235) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX L3247) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2015-04-30 |