| NPI | 1588841878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD13302) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD13302) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2010-01-05 |