| NPI | 1750811535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A-19135) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA DO-05450) |
| 207Q00000X Family Medicine (Licence: IA DO-05450) | |
| 207Q00000X Family Medicine (Licence: CA 20A-19135) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-10-12 |