| NPI | 1629502604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 54489) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01091358A) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R4865) | |
| 208D00000X General Practice (Licence: KY 54489) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2023-08-22 |