| NPI | 1659529212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A113782) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 255403) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD439970) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2015-06-03 |