| NPI | 1093338642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1025169) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 345297) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 113334) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 37698) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2026-08-26 |