| NPI | 1407696891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 14248657-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2426) |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2025-11-06 |