| NPI | 1760516439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A20813) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD00045736) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |