| NPI | 1912940305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C53920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 14557) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 14557) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C53920) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2022-07-21 |