| NPI | 1316047319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 245863) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA ML20008744) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A100854) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2019-10-21 |