| NPI | 1598769176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 12941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 12941) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2021-03-25 |