| NPI | 1174804892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C172393) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101252341) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2024-10-29 |