| NPI | 1598896144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 16540) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 16540) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2026-08-06 |