| NPI | 1508203753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MD D32108) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: DC MD31565) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2013-05-29 |