| NPI | 1982611141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD7312) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101029308) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0019262) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |