| NPI | 1972815751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 321760) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NY 321760) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60454599) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2023-04-27 |