| NPI | 1942648191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A136776) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 69169-20) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036145086) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2024-10-25 |