| NPI | 1225042401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD039373E) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00022430) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 44238) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-11-03 |