| NPI | 1386937688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101273812) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ R72665) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2023-01-27 |