| NPI | 1366481905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OK 28864) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301073723) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TN 35692) | |
| 208D00000X General Practice (Licence: TN 0000035692) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-08-13 |