| NPI | 1619297579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A118652) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2015-01602) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2023-03-14 |