| NPI | 1972122646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A177199) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A177199) |
| 174400000X Specialist (Licence: CA PTL3958) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-09-23 |