| NPI | 1467634667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M8714) |
| Additional Taxonomies | 2084P0805X (Licence: TX M8714) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2025-07-29 |