| NPI | 1790287795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0063886) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0063886) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2025-06-30 |