| NPI | 1679612626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA C172862) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 211847) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-06-01 |