| NPI | 1659971240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: KS 94-10472) |
| Enumeration Date | 2020-11-01 |
| Last Update Date | 2024-06-13 |