| NPI | 1194388330 |
|---|---|
| Former Name | BEAU DOUGLAS BATES |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 74802-21) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2023-07-19 |