| NPI | 1578511218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2005-0497) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G63150) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2012-02-28 |