| NPI | 1205526084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A198992) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A198992) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A198992) | |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2025-05-22 |