| NPI | 1871605998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX F9730) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60687291) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-10-01 |