| NPI | 1578779260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A144630) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2002007094) |
| 207W00000X Ophthalmology (Licence: MO 2002007094) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 45467) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2018-03-26 |