| NPI | 1700307238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME158690) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 319312) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T3862) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2025-03-05 |