| NPI | 1033183926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C183179) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042-110011073) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 60-27322) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 273222) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2023-01-25 |