| NPI | 1821330069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A143656) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A143656) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2018-07-13 |