| NPI | 1801183579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2022006685) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-43789) |
| 208D00000X General Practice (Licence: IN 01071601A) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2022-03-14 |