| NPI | 1891788758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-9728) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 29652) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 28798) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2021-09-27 |