| NPI | 1578315040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-13267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-13267) |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2025-08-12 |