| NPI | 1174259063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: IA MD-56936) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2026-06-03 |