| NPI | 1962445031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MS 12752) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: MS 12752) |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: MS 12752) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |