| NPI | 1053748681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19165) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 19165) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 19165) | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2024-07-29 |