| NPI | 1003173816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A164066) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A164066) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2026-02-03 |