| NPI | 1104280825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: LA 308366) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: LA 308366) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 2023-02194) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2024-08-29 |