| NPI | 1902848096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 51977) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 340447) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TPME8077) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-12-19 |