| NPI | 1790979003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT010975) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS013443) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |