| NPI | 1982348363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W5345) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TPOS1064) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 345310) | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2026-09-16 |