| NPI | 1619074002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX H3855) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: TX H3855) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |