| NPI | 1134654007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A157695) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 174400000X Specialist (Licence: CA A157695) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2024-04-03 |