| NPI | 1730240839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 013129) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 13129) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 031329) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-05-10 |