| NPI | 1497799936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR DO09573) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO09573) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: OR DO09573) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2012-02-28 |