| NPI | 1720721723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2026031928) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.156752) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 344325) | |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2026-09-01 |