| NPI | 1235266461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 51294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A95795) |
| 207Q00000X Family Medicine (Licence: AZ 51294) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A95795) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-10-20 |