| NPI | 1609396035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 92379) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD51354) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2021-00950) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 51354) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-07-11 |