| NPI | 1780085407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 18892) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18892) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2021-09-17 |