| NPI | 1861069833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U9544) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 36088) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND TSL20068) | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2026-04-06 |