| NPI | 1619985868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A37551) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX F8781) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2014-08-07 |