| NPI | 1487721791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 50549-020) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 49571) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SD 3717) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-03-30 |