| NPI | 1902033210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 31737) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101276604) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 332429) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2022-02060) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2025-11-19 |