| NPI | 1568660660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 28437) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: AZ 31022) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2011-06-22 |