| NPI | 1093120719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS019115) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT016008) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2020-02-25 |