| NPI | 1417064502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301060252) |
| Additional Taxonomies | 2084P0805X (Licence: MI 4301060252) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2026-08-24 |