| NPI | 1457812349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A177716) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 177716) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-02-15 |