| NPI | 1952976748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A198676) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A198676) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2025-06-30 |