| NPI | 1770575177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101289083) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX K0260) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2026-00462) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO CDR.0006450) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 81654) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD228860) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD70091493) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 12606R) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 342219) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2026-06-15 |