| NPI | 1205458247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 58245) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY TP479) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R5411) | |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-01-03 |