| NPI | 1891761623 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 77930) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 39185) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A77930) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2019-06-21 |