| NPI | 1154774321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 307462) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 1154774321) |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2020-12-23 |