| NPI | 1912175746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A108196) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2014-03-25 |