| NPI | 1104561026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD600005668) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 111844) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 344357) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301517241) | |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2026-08-05 |