| NPI | 1174605067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A10813) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10813) |
| 208D00000X General Practice (Licence: AZ 4168) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2021-07-29 |