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 |