| NPI | 1962620740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: AR E-6668) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: DC MD037305) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2012-07-06 |