| NPI | 1144226630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X (Licence: PA MD476205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 44908) |
| 2084P0805X (Licence: MA 44908) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2026-08-25 |