| NPI | 1063079739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A190695) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A190695) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2026-10-20 |