| NPI | 1447992573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2025050009) |
| 207R00000X Internal Medicine (Licence: KS 95-00081) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 95-00081) | |
| Enumeration Date | 2022-04-09 |
| Last Update Date | 2026-01-23 |