| NPI | 1386227866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 2022-02532) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC JOHN-J00N7O) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2022-10-05 |