| NPI | 1942316963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD16276) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00026575) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-12 |