| NPI | 1396189791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A149842) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD221600) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-145711) | |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2025-04-09 |