| NPI | 1194319277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101276833) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101276833) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2025-07-01 |