| NPI | 1750431953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 8745) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 8745) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2013-04-22 |