| NPI | 1639193659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G83339) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD042185L) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2013-01433) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-07-31 |