| NPI | 1669453262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA A84067) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX P0883) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A84067) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P0883) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A84067) | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA A84067) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2022-05-16 |