| NPI | 1811903842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 49152) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 43850-20) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 73822) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2026-04-29 |