| NPI | 1174742357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301102666) |
| Additional Taxonomies | 2084P0805X (Licence: MI 4301102666) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2026-03-09 |