| NPI | 1285297895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: FL ME165216) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: MA 1014663) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2024-08-01 |