| NPI | 1750597688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G50347) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G50347) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 6308) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: HI 6308) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA G50347) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2019-05-22 |