| NPI | 1811740343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 3585) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A24483) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2025-11-24 |