| NPI | 1497734461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: TN 48549) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 054333) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 243838) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2012-09-05 |