| NPI | 1003242447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 5483) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5483) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2022-04-07 |