| NPI | 1760616551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q0845) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA DO000296) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2025-05-20 |