| NPI | 1710637244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 343302) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2026-00109) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 37649) | |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2026-07-27 |