| NPI | 1881688505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA C53918) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: MD D41236) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 078926) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2021-12-17 |