| NPI | 1245734375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 64901) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R4711) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY TP093) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 55979) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2022-10-10 |