| NPI | 1891718714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-22574) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 110209) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 39074) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 20902) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-05-17 |