| NPI | 1760692032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 62451) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 267988) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 70074) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD445628) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01066962A) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-03-11 |