| NPI | 1356908776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: TX U0462) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NM MD2026-0164) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2026-04-15 |