| NPI | 1649290362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 16179) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 16179) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-06-08 |