| NPI | 1003870379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101244688) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-15170) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 34578) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD.MD.61113530) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-11-25 |