| NPI | 1043276918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2014-2016) |
| Additional Taxonomies | 2084P0805X (Licence: PA MD046886L) |
| 2084P0805X (Licence: AZ 54604) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2025-08-29 |