| NPI | 1366550246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C56113) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 6301005008) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P7701) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-06-08 |