| NPI | 1386680353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 63134) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M8442) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 27154) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2021-07-02 |