| NPI | 1013657600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2026-01986) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NC 2026-01986) | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-05-23 |