| NPI | 1285898940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.095855) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 321409) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P1954) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2022-06-27 |