| NPI | 1669903308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 179273) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01087664A) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 87593) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA11337300) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.145030) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2022019098) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 299748-01) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME157307) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD478075) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2026-08-11 |