| NPI | 1972995892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 5992) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5992) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2021-01-25 |