| NPI | 1841602315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A15960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-04896) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA DO-04896) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-02-24 |