| NPI | 1417000852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G33962) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: UT 9213117-1205) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA G-33962) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD00033116) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-01-17 |