| NPI | 1639412091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA A132680) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A132680) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2023-06-21 |