| NPI | 1013405323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 92525) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME155200) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-05-12 |