| NPI | 1225008832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC 17355) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 17355) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-09-17 |