| NPI | 1154669844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ND PT17661) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 39818) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2021-09-27 |