| NPI | 1285214585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 349425) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME169911) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 331069) | |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2025-12-03 |