| NPI | 1295110542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2018034942) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2015026257) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2021-10-20 |