| NPI | 1558990259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2025-00981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2025-00981) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2025-07-01 |