| NPI | 1992385652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 4596) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 334391) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1022573) | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-11-10 |