| NPI | 1861136996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD.61583653) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 344674) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 29741) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.155775) | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2026-09-03 |