| NPI | 1184316333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2022047511) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2022047511) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2023-08-01 |