| NPI | 1710942834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 24006) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 0243656) |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: NC 24006) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2015-09-25 |