| NPI | 1417586165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS026369) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A21476) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE C2-0025092) | |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2026-08-11 |