| NPI | 1184640286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G24955) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA G24955) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2010-04-20 |