| NPI | 1629636154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A22859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019117) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-07-26 |