| NPI | 1114461530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R2558) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS19903) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2026-07-20 |