| NPI | 1578727061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID 9771254) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SD 18221) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2026-06-21 |