| NPI | 1831484930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A137683) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 75223) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 75223) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2018-05-08 |