| NPI | 1881445781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A205350) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A205350) |
| 2084P0805X (Licence: CA A205350) | |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2025-11-05 |