| NPI | 1558681429 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 67679) | 
| Additional Taxonomies | 2084P0805X (Licence: TX 3339) | 
| Enumeration Date | 2010-06-02 | 
| Last Update Date | 2025-09-10 |