| NPI | 1205415262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A180895) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PTL6422) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2024-04-24 |