| NPI | 1528454204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S1994) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A144155) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A144155) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2021-08-12 |