| NPI | 1134398233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A100824) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A100824) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A100824) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2025-02-10 |