| NPI | 1255957874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: CA A193470) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2025-06-20 |