| NPI | 1275580466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G163051) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2007-0146) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0014674) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60981854) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD167289) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 18785) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-02-12 |