| NPI | 1245438126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A21187) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58.002280) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2025-06-22 |