| NPI | 1376120063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: CA A195292) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2026-05-06 |