| NPI | 1679150296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 81337) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 31629) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 71949) | |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2025-06-24 |