| NPI | 1063894418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ZZ 7088454) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 80881) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-03-04 |