| NPI | 1063915833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM DO2023-0500) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0102209329) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NM DO2023-0500) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-17 |
| Last Update Date | 2025-07-11 |