| NPI | 1538489810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C170376) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301105192) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R6305) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2025-03-14 |