| NPI | 1164900205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX U0419) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IL 036164639) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: TX U0419) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2024-02-19 |