| NPI | 1669093860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 13781591-1204) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2022-00744) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 260938) | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-06-18 |