| NPI | 1376002683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A180657) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A180657) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2022-08-03 |