| NPI | 1265417208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G48469) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G48469) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2025-03-14 |