| NPI | 1629270442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M6893) |
| Additional Taxonomies | 2084P0805X (Licence: TX M6893) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2019-07-17 |