| NPI | 1174944805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 19211) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101026534) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS017854) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS14555) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT015401) | |
| Enumeration Date | 2013-12-24 |
| Last Update Date | 2023-10-10 |