| NPI | 1265621791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A103383) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A103383) |
| 208000000X Pediatrics (Licence: CA A103383) | |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2020-12-10 |