| NPI | 1669463592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 015884) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CT 15884) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2018-10-30 |