| NPI | 1902296692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A175731) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 68114-20) |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2023-03-06 |