| NPI | 1588284632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: TX V5957) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 327536) |
| Enumeration Date | 2020-04-19 |
| Last Update Date | 2025-08-08 |