| NPI | 1518428127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0073016) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS17210) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2026-04-05 |