| NPI | 1689654493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 15962) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 33760) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2007022043) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2013-04-24 |