| NPI | 1205369287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY TL9148) |
| Additional Taxonomies | 2085R0001X (Licence: UT 10957101-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-10457) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2026-07-17 |