| NPI | 1962758698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CA A173156) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CT 54819) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2021-12-30 |