| NPI | 1588168025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 81856) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 81856) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 81856) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-01-11 |