| NPI | 1861989766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A163403) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2022-05-26 |