| NPI | 1750449732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 51181) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 52896) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-91589) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-15356) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q6338) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2021-05-14 |