| NPI | 1275694028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MD D0045248) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MD D0045248) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2025-04-29 |