| NPI | 1982781944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60319510) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 248541) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 7308) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-02-04 |