| NPI | 1063065506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A180355) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A180355) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2026-06-08 |