| NPI | 1013497981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 85379-20) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301513373) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME158273) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S6730) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME158273) | |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2025-03-12 |