| NPI | 1295810760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C53228) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME88133) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 211990) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-06-15 |