| NPI | 1093377152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A23826) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 307158) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA 20A23826) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 307158) | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2025-07-01 |