| NPI | 1417319997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T4501) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A150883) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 77909) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0018472) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2025-09-18 |