| NPI | 1235232802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A29118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A29118) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A29118) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2015-07-14 |