| NPI | 1063527950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 152835) |
| Additional Taxonomies | 2084P0805X (Licence: MA 152835) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-04-03 |