| NPI | 1154070068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 97260) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 13718) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 13718) | |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2023-09-19 |