| NPI | 1982137519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A160795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A160795) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD482898) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2025-10-15 |