| NPI | 1679578736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: WV 19159) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WV 19159) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2009-11-18 |