| NPI | 1760913867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: CA 187347) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2023-10-27 |