| NPI | 1609811132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C51757) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME107977) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35043424P) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2022-09-08 |