| NPI | 1528206489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A50038) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA A50038) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2026-03-10 |