| NPI | 1073551032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A63721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA DEA BR5656030) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A063721) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2012-03-10 |