| NPI | 1003014374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 43138) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 6150978-1205) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2026-03-13 |