| NPI | 1851978175 |
|---|---|
| Former Name | GREGORY JEBIAN BASTOURI |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 12985853-1205) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-08-01 |