| NPI | 1093383325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 85467) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 9011) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2025-08-20 |