| NPI | 1396372637 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 32795) | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 1.080599-RES) | 
| Enumeration Date | 2020-03-26 | 
| Last Update Date | 2025-06-25 |