NPI | 1174899595 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 285762) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60647844) |
Enumeration Date | 2012-03-29 |
Last Update Date | 2020-12-18 |