| NPI | 1023376936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C189669) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME140097) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN none) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN none) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2023-12-21 |