| NPI | 1598335200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD485767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT224357) |
| Enumeration Date | 2021-06-26 |
| Last Update Date | 2024-07-17 |