| NPI | 1902014780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA g77412) |
| Additional Taxonomies | 2084P0805X (Licence: CA g77412) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-02-13 |