| NPI | 1174528350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A88474) |
| Additional Taxonomies | 2084P0805X (Licence: CA A88474) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2026-03-10 |