| NPI | 1154959161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME169016) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301512580) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 93628) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 71935) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-03-10 |