| NPI | 1679044523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME148989) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN27909) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A178197) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2026-01-27 |