| NPI | 1104362565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD047964) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101274456) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0092109) | |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2022-07-19 |