| NPI | 1053597138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G55616) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00040757) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: CA G65616) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: WA MD00040757) | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-01-18 |