| NPI | 1588752364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO MOR1K15) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO r1k15) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-11-02 |