| NPI | 1093878134 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084P0805X (Licence: CA G48528) | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G48528) | 
| Enumeration Date | 2006-12-19 | 
| Last Update Date | 2025-07-14 |