| NPI | 1972873479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2022-02511) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD025623E) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME123745) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-23125) | |
| Enumeration Date | 2011-12-31 |
| Last Update Date | 2025-07-06 |