| NPI | 1013570811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T2384) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0071529) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 324874) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2023-07-10 |