| NPI | 1619543758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 05-50811) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2025016117) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151014997) | |
| Enumeration Date | 2021-05-30 |
| Last Update Date | 2025-09-03 |