| NPI | 1144964636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA OS024715) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA OT021472) |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2025-05-27 |