| NPI | 1477331098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA 34319) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 34319) |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2024-04-11 |