| NPI | 1043277700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A82909) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA A82909) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2017-07-17 |