| NPI | 1194808980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CA A45231) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A45231) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-02-01 |