| NPI | 1073655304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD427220) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD00047571) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ND 12684) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MT MED-PHYS-LIC-33317) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO DR.0069079) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-03-08 |