| NPI | 1649774423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W0546) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A191847) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2022-00639) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-11-13 |