| NPI | 1225083272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C53102) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SD 5295) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 46626) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-04-02 |