| NPI | 1720615370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A187721) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A187721) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A187721) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-07-30 |