| NPI | 1053416701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G85915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G85915) |
| 207R00000X Internal Medicine (Licence: CA G85915) | |
| 207RC0200X Internal Medicine Critical Care Medicine (Licence: CA G85915) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2012-10-01 |