| NPI | 1235690900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 336146) |
| Additional Taxonomies | 2084H0002X (Licence: LA 336146) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2024-10-29 |