| NPI | 1831517697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A137631) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A137631) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2018-08-27 |