| NPI | 1699979682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101250482) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2014-10-08 |