| NPI | 1669059697 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T8818) | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A23972) | 
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0075136) | |
| Enumeration Date | 2021-03-25 | 
| Last Update Date | 2025-10-27 |