| NPI | 1679065536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A196580) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 2022-02255) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 1679065536) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME157036) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101270967) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-08-15 |