| NPI | 1639278104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: HI 5407) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: HI 5407) |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: HI 5407) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-02-01 |