| NPI | 1962933069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A206130) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 297711-1) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2022-0573) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2025-11-25 |