| NPI | 1205282878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4351049278) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 16494-40) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2023-05-05 |