| NPI | 1629507744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 009168) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0062468) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0006680) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2022-06-28 |