| NPI | 1497286512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME145180) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W2258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A174439) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2026-09-13 |