| NPI | 1730444274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 253184) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 150220) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 25490) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2025-05-22 |