| NPI | 1194399626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A24141) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT020674) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2025052739) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS22156) | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-02-07 |