| NPI | 1952501249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101280107) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 24598) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2026-04-03 |