| NPI | 1730391889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 50799) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 49210) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2024-06-10 |