| NPI | 1962472654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301040701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301040701) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2014-01-30 |