| NPI | 1497215560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A204593) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U2917) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2025-04278) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 340610) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 246396) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-25518) | |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2026-01-21 |