| NPI | 1790343887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5151013784) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A21164) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2024-04-15 |