| NPI | 1932515970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W9212) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM RS2014-0544) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2018-0118) | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2026-09-18 |