| NPI | 1619008075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301504381) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 08721R) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-09-15 |