| NPI | 1417061094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A80967) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2004012777) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 084576) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2010-12-07 |