| NPI | 1821019803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 07322R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 07322R) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2016-06-02 |