| NPI | 1992146005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 71077-21) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 66187) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 269989) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 255809) | |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2022-07-25 |