| NPI | 1043576457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A129550) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2015-02-04 |