| NPI | 1043259690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301031628) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 54004) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD227709) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2025-11-10 |