| NPI | 1053815167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME158904) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A177008) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101278925) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2024-02-21 |