| NPI | 1982653135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A7900) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA 20A7900) |
| 2084P0805X (Licence: CA 20A7900) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2019-11-11 |