| NPI | 1508362955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 83807) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A17626) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 20A17626) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2024-03-14 |