| NPI | 1922447960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME156827) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN MDST768) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35131835) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 11396A) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2023-09-28 |