| NPI | 1174539779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00023405) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD12619) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G46711) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-12795) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 9182572-1205) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2017-03-06 |