| NPI | 1336159938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00036116) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C52500) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 11802) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2024-03-18 |