| NPI | 1205034287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A123454) |
| Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA 123454) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2020-06-09 |