| NPI | 1528565025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 34.014481) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: OH 34.014481) | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2021-06-21 |