| NPI | 1558708578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A14836) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102204323) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA 20A14836) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0102204323) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2021-04-26 |