| NPI | 1790198430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D77997) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD32597) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2019-04-24 |