| NPI | 1326570953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61624247) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 83594) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2025-09-26 |