| NPI | 1932187143 |
|---|---|
| Other Name | NONE NONE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 128480) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN MD19665) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2021-04-08 |