| NPI | 1649345067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A96503) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A96503) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2012-10-24 |