| 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 |