| NPI | 1255644118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA IMLC.MD.61164093) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT196759) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2021-09-15 |