| NPI | 1245647841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 292902) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL OS13716) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR DO187792) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2023-01-13 |