| NPI | 1417367186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A155672) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ R74333) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 65371) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 33889) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2025-07-30 |