| NPI | 1770575177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 12606R) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO CDR.0006450) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 342219) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2026-03-26 |