| NPI | 1669654984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: CT 46789) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 390200000X) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 46789) | |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2016-08-24 |