| NPI | 1902918675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C51171) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX J0131) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 221607) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-02-25 |