| NPI | 1649459611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 5167481) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 20933) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G51685) | |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2007-10-26 |