| NPI | 1619986809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD008903E) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: DE C1-0002479) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |