| NPI | 1750968913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 111906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO7924) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL UO7924) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2026-06-16 |