| NPI | 1518096288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ 28889) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 28889) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2025-09-11 |