| NPI | 1265639611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A133144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN11500) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-04-27 |