| NPI | 1467972547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ID M-15643) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KS 94-09347) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2021-06-16 |