NPI | 1043479850 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102201883) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201883) |
Enumeration Date | 2008-06-06 |
Last Update Date | 2024-01-05 |