| NPI | 1396923868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G13419) |
| Additional Taxonomies | 2084P0805X (Licence: CA G13419) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2011-08-16 |