| NPI | 1558856625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 18020) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2023-10-10 |