| NPI | 1356388102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 0017668) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 17668) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-06-13 |