| NPI | 1164508362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A39953) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 210378) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 027471) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2021-10-20 |