| NPI | 1063831204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX 47287) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IL 125065592) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-06-02 |