| NPI | 1689300691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 9440) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 9440) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2023-05-17 |