NPI | 1679128052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 73231) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2024-00914) |
Enumeration Date | 2019-08-02 |
Last Update Date | 2024-09-26 |