| NPI | 1023245198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 821) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA a2010730) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2019-08-28 |