| NPI | 1598965998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NV 13792) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NV LL1746) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2020-06-09 |