| NPI | 1366440323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD175003) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G59726) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD11748) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2021-05-28 |