| NPI | 1467972836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A173471) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA MTL004190) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2021-08-30 |