| NPI | 1740269364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G86996) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME73418) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 14036) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2019-06-03 |