| NPI | 1326367038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 61298-20) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 4310-850) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2022-07-15 |