| NPI | 1225414428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C187310) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 73530) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2023-09-28 |