| NPI | 1023770039 |
|---|---|
| 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: OK 8582) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2024-08-08 |