| NPI | 1568924611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 33206) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 33206) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A198420) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 330677) | |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2025-12-02 |