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 |