| NPI | 1134610983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2024-03141) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 305107) |
| Enumeration Date | 2018-05-28 |
| Last Update Date | 2025-01-09 |