| NPI | 1578128682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-47761) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS pending) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2021025243) | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2023-06-24 |