| NPI | 1053341073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A93642) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A93642) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2011-08-11 |