| NPI | 1609863901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 7962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 7962) |
| Enumeration Date | 2005-10-02 |
| Last Update Date | 2010-02-01 |