| NPI | 1366789141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 191616) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 14214384-1205) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101256750) | |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2025-09-19 |