| NPI | 1932472883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A123663) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 104204) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME157962) | |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2025-08-04 |