| NPI | 1538604608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A182212) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD W-160-234-288-308) |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2023-07-10 |