| NPI | 1740861327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME169778) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 338417) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX BP10076665) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2025-10-24 |