| NPI | 1639732845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A195875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A195875) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-10-01 |