| NPI | 1255758793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 10588322-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021267) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5315066358) | |
| Enumeration Date | 2014-03-22 |
| Last Update Date | 2018-04-18 |