| NPI | 1629224100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD28445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD28445) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2013-08-21 |