| NPI | 1023496486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 321943) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102204640) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U4148) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2025-04-17 |