| NPI | 1154686541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 23662) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS T-2608) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2026-06-22 |