| NPI | 1750860524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 34795) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 34795) |
| Enumeration Date | 2018-08-12 |
| Last Update Date | 2023-07-13 |