| NPI | 1942344890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 44990) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 44990) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2023-04-03 |