| NPI | 1336776822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX V5826) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 315845) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME168844) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 1.079972) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 102895) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-10-29 |