| NPI | 1679591259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 7453) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 21186) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2011-11-30 |