| NPI | 1962452862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101055932) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC 89656) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2024-01-08 |