| NPI | 1992833099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA 165035) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation Brain Injury Medicine (Licence: GA 56360) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CA 165035) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: GA 56360) | |
| 2084P0301X Psychiatry & Neurology Brain Injury Medicine (Licence: CA 165035) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CA 165035) | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: GA 56360) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2023-01-20 |