| NPI | 1003089145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A130534) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 8219595-1205) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 248104) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2022-01-12 |