| NPI | 1255793246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX T5052) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: TX T5052) |
| 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: CA A150336) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A150336) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2023-06-27 |