| NPI | 1083957187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A154252) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MO 2018015765) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2018015765) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2020-04-02 |