| NPI | 1053365270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A76392) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A76392) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2014-03-28 |