| NPI | 1366756819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 83730) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 080492) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2025-05-30 |