| NPI | 1821364498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IN 01086475A) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: IN 01086475A) |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: WI 61391) | |
| 208D00000X General Practice (Licence: WI 60291) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2022-02-18 |