| NPI | 1538378393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A120113) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00049014) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 19575) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-03-08 |