| NPI | 1023178019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CA G72412) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G72412) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-03-12 |