| NPI | 1285727271 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0805X  (Licence: CA A51504)  | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A51504)  | 
| Enumeration Date | 2006-10-02 | 
| Last Update Date | 2019-05-23 |