| NPI | 1790862225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2008021138) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 05-33192) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101022923) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2024-11-08 |