| NPI | 1023455359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A134060) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A134060) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CA 2426) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2020-03-24 |