| NPI | 1720307051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A113520) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A113520) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A113520) | |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2023-04-05 |