| NPI | 1679691356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A103502) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 238286) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2019-07-02 |