| NPI | 1528027174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C54990) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2005-01346) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M3529) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2021-12-01 |