| NPI | 1851598668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 23697) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0103947) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 337336-01) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101285741) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2025-09-07 |