| NPI | 1275673584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A98275) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A98275) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2012-01-12 |