NPI | 1568455939 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 48253) |
Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: MA 48253) |
Enumeration Date | 2005-08-31 |
Last Update Date | 2007-07-08 |