| NPI | 1922629112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A183194) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A183194) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2026-08-16 |