| NPI | 1659875961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A184500) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D96180) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S4025) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-07-20 |