| NPI | 1689879512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101232726) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD036105) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C42189) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 32254) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2012-10-16 |