| NPI | 1902465735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61468187) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101285287) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD489287) | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-04-16 |