| NPI | 1568903797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2021025201) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 05-50085) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 332626) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2024-11-07 |