| NPI | 1194709998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 12199014-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G50476) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 066799) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2021-12-01 |