| NPI | 1750904587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T5826) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 343748) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 345943) | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2026-07-15 |