| NPI | 1417489774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 202100603) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC 86392) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN24684) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2021-09-29 |