| NPI | 1871028126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 62326) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 204807) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX V9465) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2025-12-09 |