| NPI | 1376513846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A32173) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A32173) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2007-07-08 |