| NPI | 1134756711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE C1-0028381) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD491038C) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0101087) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1024512) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25IA12758200) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-12-01 |