| NPI | 1669000485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MS 29102) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 29102) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2024-09-06 |