| NPI | 1134500614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T5355) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-19265) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME-153190) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2026-02-20 |