| NPI | 1477795201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 17541) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 122623) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2021-07-07 |