| NPI | 1053625012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 13430) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 13430) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MS 13430) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2025-06-17 |