| NPI | 1699270181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A164179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A164179) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2023-08-07 |