| NPI | 1609958610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 188582-1205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00011062) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 17775) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |