| NPI | 1225777311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 21334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL18551) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2026-07-02 |