| NPI | 1487235818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX V9840) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101278312) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101278312) | |
| Enumeration Date | 2021-04-17 |
| Last Update Date | 2025-09-19 |