| NPI | 1104186899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA 20A13131) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ R2153) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2018-06-20 |