| NPI | 1760942437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 185592) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 307659) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 61450297) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-08-10 |