| NPI | 1740546209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A120383) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A120383) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A120383) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2024-10-30 |