| 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 |