| NPI | 1972733061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MT190474) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD441059) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2010-09-09 |