| NPI | 1053458216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2002013720) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-33401) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 41627) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2022-07-21 |