| NPI | 1942309810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D29531) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 50366) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-17810) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2018-08-01 |