| NPI | 1194162453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO CDRH.0000079) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 1352) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2023-07-25 |