| NPI | 1124155791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA NOT YET APPLIED) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA NOT YET APPLIED) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2014-01-13 |