| NPI | 1518340728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61484786) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 263521) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 67904) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2025-05-08 |