| NPI | 1679749980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR 017648) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR MD17648) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2024-04-23 |