| NPI | 1912079518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A24509) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD0026639) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101030772) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 60455) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-05-18 |