| 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 |