| 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 |