| NPI | 1649201344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 1630398905) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 1630391205) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |