| NPI | 1164597472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 48635) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A040218) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-10877) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-02-24 |