| NPI | 1528325412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A129587) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A129587) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2025-08-25 |