| NPI | 1114373370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A152488) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A152488) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2020-10-23 |