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 |