| NPI | 1730276882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 22535) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 42278) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2009-05-01 |