| NPI | 1841395662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A13233) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS002620L) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 5117) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV DO1655) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101019613) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2015-03-10 |