| NPI | 1134703523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO7861) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CT 81740) | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2025-07-30 |