| NPI | 1548840614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A196729) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC RTL21-1150) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL) | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2026-05-03 |