| NPI | 1821075805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 01189) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 34364) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC 13002) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2007-07-08 |