| NPI | 1649633124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A202310) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 337408) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101262876) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2025-09-30 |