| NPI | 1902251143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA 20A15742) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CA 20A15742) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CA 20A15742) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2024-04-04 |