| NPI | 1366762106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A120199) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH AC2822890-K10-018) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2023-03-07 |