| NPI | 1497469134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN42144) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN42144) |
| 164W00000X Licensed Practical Nurse (Licence: FL PN5189467) | |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-08-17 |