| NPI | 1013104827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A110831) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 51710) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2011-04-04 |