| NPI | 1427506955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A157092) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 67556) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2022-10-18 |