| NPI | 1003242744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R3776) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL UO3477) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS15001) | |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2025-02-19 |