| NPI | 1417570714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2024-01038) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151014565APP20) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151014565) | |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2024-05-14 |