| NPI | 1083173132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A191230) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME160898) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301509475) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-07-11 |