| NPI | 1225118805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101029745) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 101029745) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-05-08 |