| NPI | 1821330960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A131478) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A131478) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2021-04-27 |