| NPI | 1477703387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 17743) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 27276-R) |
| Enumeration Date | 2008-09-27 |
| Last Update Date | 2016-03-16 |