| NPI | 1619407475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS17492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS17492) |
| 207R00000X Internal Medicine (Licence: FL OS17492) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-01-11 |