| NPI | 1174782965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL 135586) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IN 390200000X) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2022-12-08 |