| NPI | 1285261578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A204210) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T2561) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD500002860) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-07-31 |