| NPI | 1124494646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G13524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G13524) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 5510) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2020-02-24 |