Individual
DI MU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 ALLEGHENY AVE STE 1202, TOWSON, MD 21204-3919
(443) 470-9065
(410) 825-2979
Mailing address
28 ALLEGHENY AVE STE 1202, TOWSON, MD 21204-3919
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D0080459
MD
Other
Enumeration date
05/23/2011
Last updated
05/23/2019
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