| NPI | 1518150473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G85992) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 24660) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2007-09-14 |