| NPI | 1336295922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 45693) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR DO29275) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1307) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2022-04-29 |