| NPI | 1790760106 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084H0002X Psychiatry & Neurology, Hospice and Palliative Medicine (Licence: CA C54266)  | 
| Additional Taxonomies | 2084H0002X Psychiatry & Neurology, Hospice and Palliative Medicine (Licence: NY 143908)  | 
| Enumeration Date | 2005-12-08 | 
| Last Update Date | 2014-07-21 |