NPI | 1730444274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 253184) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 150220) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 25490) | |
Enumeration Date | 2012-07-11 |
Last Update Date | 2025-05-22 |