| NPI | 1194881888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G23317) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G23317) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2023-03-07 |