| NPI | 1164874954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MS 28429) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: LA 322579) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OK 32359) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 32359) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2023-02-01 |