| NPI | 1003347063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A157209) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: TX T6562) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CA A157209) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T6562) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2024-04-30 |