| NPI | 1679704779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 193200000X Multi-Specialty (Licence: FL OS12212) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS12212) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2016-08-08 |