NPI | 1003107699 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR 207172) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A122499) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 61207081) | |
Enumeration Date | 2011-04-29 |
Last Update Date | 2022-10-25 |