| NPI | 1265991640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102207468) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102207468) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2025-08-06 |