| NPI | 1710071006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A66734) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD221586) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61584187) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-05-07 |