| NPI | 1821072950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A109440) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD 9499) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME83506) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-11-04 |