| NPI | 1396743670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 34055) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G48495) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 24835) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2009-05-05 |