| NPI | 1689202202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1023528) |
| Additional Taxonomies | 2084P0805X (Licence: MA 1023528) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-07-16 |