| NPI | 1740244912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 5707) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 77-160317-1205) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2007-07-08 |