| NPI | 1255467577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 153464) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 25488) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD25776) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2023-05-11 |