| NPI | 1386041069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: WI 2114) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD463429) |
| 208VP0000X (Licence: MN 81783) | |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2026-02-27 |