NPI | 1457693319 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 265418) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 67250) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 309200000x) | |
Enumeration Date | 2013-03-19 |
Last Update Date | 2023-09-12 |