| NPI | 1578529491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA OP61017747) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WY 5405A) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-10-21 |