| NPI | 1124605209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA OS024615) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 34.016212) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-07-02 |