| NPI | 1689959421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 35543) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT 196274) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-8395) | |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2020-08-13 |