NPI | 1548472491 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C41874) |
Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: CA AW322549) |
Enumeration Date | 2007-05-04 |
Last Update Date | 2008-07-16 |