| NPI | 1235371493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 005517) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ R1049) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2016-12-01 |