| NPI | 1750949731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 109869) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 341079) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD89667) | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2026-09-23 |