| NPI | 1073183265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X (Licence: NC 2026-01992) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 39411) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2026-06-17 |