| NPI | 1942438254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A116491) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 25882) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2020-02-07 |