| NPI | 1780603654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 4647) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: HI DOS-944) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-12-19 |