| NPI | 1265695563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A120812) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301100016) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2021-09-03 |