| NPI | 1649257460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK AA2849) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A36936) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD11166) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-10-21 |