| NPI | 1932698180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME18084) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2025011861) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC LL51927) | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2025-05-03 |