| NPI | 1902229701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 15570) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 108417) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 17894) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME92860) | |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2014-01-29 |