| NPI | 1003109745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 53686) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 25255) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2022025738) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2022-12-01 |