| NPI | 1104845304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX L5857) |
| Additional Taxonomies | 2084P0805X (Licence: TX L5857) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2026-05-29 |