| NPI | 1912402496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA a164022) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A164022) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-08-23 |