| NPI | 1023688843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OK 7766) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 0477R) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2025-08-04 |