| NPI | 1720170228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 14728A) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-13088) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD24828) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2024-04-01 |