| NPI | 1225198708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G153534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00021837) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00021837) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-07-21 |