| NPI | 1821088071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 47770) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 5584) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2010-10-27 |