| NPI | 1619052461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD202383) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T8222) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI md13592) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2026-04-10 |