| NPI | 1477131977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102207464) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX BP10073764) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2023-04-02 |