| NPI | 1124322151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: AZ 27112) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: AZ 27112) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CA G72139) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G72139) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: CA G72139) | |
| 208D00000X General Practice (Licence: AZ 27112) | |
| 208D00000X General Practice (Licence: CA G72139) | |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |