| NPI | 1811525611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A187303) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2023-07-27 |