| NPI | 1700821709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G42267) |
| Additional Taxonomies | 208VP0000X (Licence: CA G42267) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA G42267) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2015-09-01 |