| NPI | 1659543874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C168670) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036.119633) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME TD081067) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2021-06-09 |