| NPI | 1538489810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301105192) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105192) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-07412) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2023-09-21 |