| NPI | 1700099264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A122589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A122589) |
| 207Q00000X Family Medicine (Licence: WV 22903) | |
| 207Q00000X Family Medicine (Licence: VA 0101251845) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101251845) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 22903) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2021-12-15 |