| NPI | 1932276425 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME96275) | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MMD.94602MD) | 
| Enumeration Date | 2006-11-29 | 
| Last Update Date | 2025-06-13 |