| NPI | 1548649080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO DR.0062021) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60969938) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX R8720) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10054454) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2023-01-30 |