| NPI | 1659531994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CA A 118822) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified (Licence: CA RCP 18139) |
| 363AM0700X Physician Assistant Medical (Licence: CA PA 15737) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2022-06-27 |