| NPI | 1629424114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2022-03046) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 51870) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2026-05-27 |