| NPI | 1073045381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A178097) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD D0086815) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-01-06 |