| NPI | 1003566415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 345635) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W7799) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME182956) | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2026-07-16 |