| NPI | 1770574857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 25516) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 11357) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2009-12-14 |