| NPI | 1982751756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A 103818) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: TX U0669) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2025-10-15 |