| NPI | 1235330523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 28489) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-47545) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301089814) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301089814) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2023-12-11 |