| NPI | 1619043130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A86011) |
| Additional Taxonomies | 2084P0805X (Licence: CA A86011) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2026-02-18 |