| NPI | 1073959722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61053828) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 49868) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD461709) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2022-12-04 |