| NPI | 1669580270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: CA G070125) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01069658) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2014-08-20 |