| NPI | 1083696520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C53488) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 014143) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 14237) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2012-09-13 |