| NPI | 1518950625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301030825) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA 17493) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2007-07-08 |