| NPI | 1437382389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME175114) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301093049) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61156718) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2025-07-24 |