| NPI | 1043224074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G36252) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA G36252) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-07-19 |