| NPI | 1801141973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 270775) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60652939) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2022-07-21 |