| NPI | 1497286355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 84188) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 84188) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2022-12-30 |