| NPI | 1245792134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A179260) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 2192) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-03-28 |