| NPI | 1497174023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A136661) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 174400000X Specialist (Licence: CA A136661) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2016-08-01 |