| NPI | 1275507642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 101273496) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 24407) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 33016) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2024-01-02 |