| NPI | 1568111011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 35303) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME167437) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2024-07-03 |