| NPI | 1366684581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301075190) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 047514) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101245357) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2019-03-05 |