| NPI | 1487606547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME92093) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX D6691) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 6772A) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 41044) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 23668) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2009-09-14 |