| NPI | 1073506952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A75992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A75992) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2007-10-02 |