| NPI | 1881191153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 166808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 166808) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2020-05-12 |