| NPI | 1205570066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W6391) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 111695) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 343075) | |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2026-05-20 |