| 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 |