| NPI | 1356970743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 104269) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 104269) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 157206) | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-05-08 |