| NPI | 1306691027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA 20A24365) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A24365) |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2025-07-14 |