| NPI | 1124136627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 20148) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301055676) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 179676) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 00031786) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2020-12-30 |