| NPI | 1386617421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA C158794) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD425314) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-05-31 |