| NPI | 1205572443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2023-03369) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC HORS-H0HO3N) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2023-12-27 |