| NPI | 1194303891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A201674) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301514528) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 334091) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0074577) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-04-07 |