| NPI | 1134707722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A180697) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 174400000X Specialist (Licence: CA 6358) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2023-07-11 |