NPI | 1568041523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A201569) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD210002717) |
208D00000X General Practice (Licence: DC MD210002717) | |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D98142) | |
Enumeration Date | 2021-04-06 |
Last Update Date | 2025-07-08 |