| NPI | 1598869653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 43117) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 21472) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME111718) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2023-02-13 |