| NPI | 1245925916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 13488) |
| Additional Taxonomies | 273R00000X Psychiatric Unit |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2024-06-12 |