| NPI | 1659883320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2023016866) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2017033426) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2023-05-08 |