| NPI | 1174507347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A054270) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 5494) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 7405) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-05-11 |