| NPI | 1770656852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2001014723) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD27609) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2015-12-21 |