| NPI | 1225093990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101036870) |
| Additional Taxonomies | 2084P0805X (Licence: VA 01010368780) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2025-02-24 |