| NPI | 1922663822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX V6488) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 7132) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS22045) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2025-06-09 |