| NPI | 1679662662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101233941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101223941) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2011-09-28 |