| NPI | 1336887439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A195304) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A195304) |
| 208D00000X General Practice (Licence: CA A195304) | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2025-01-27 |