| NPI | 1700987484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 48588-020) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 48588-020) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |