| NPI | 1881936177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO Dr.0062327) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0013408) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 67066) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2019-10-25 |