| NPI | 1063946275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: CA 158808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 318303) |
| 207Q00000X Family Medicine (Licence: CA 158808) | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: NY 318303) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2026-05-12 |