| NPI | 1720142599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN MD008653) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G86305) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 3474) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-04-22 |