| NPI | 1659957546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 341375) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX V1493) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-12-30 |