| NPI | 1386824753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C133036) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 12370) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 46519) | |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2024-07-02 |