| NPI | 1538153556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 20300) |
| Additional Taxonomies | 2084P0805X (Licence: TN 20300) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2020-09-28 |