| NPI | 1831192293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME59988) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301060662) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 52715) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2011-01-16 |