| NPI | 1225563299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 157766) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A157766) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2019-07-18 |