| NPI | 1184851792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2013008083) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 69809) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-16999) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2025-09-15 |