| NPI | 1316525298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 36632) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0077757) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 344393) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME182195) | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-06-05 |