| NPI | 1023696085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2026-02564) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2026-02564) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-05-11 |