| NPI | 1710918206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N8347) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 151833) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G137265) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2025-01-30 |