| NPI | 1962485417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 8528) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PR 8528) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: PR 8528) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2016-10-06 |