| NPI | 1205152832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD157362) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60626573) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C161420) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2024-07-29 |