| NPI | 1639521347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 65689) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 32184) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 32184) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2022-04-20 |