| NPI | 1700450889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4351048533) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: OH 35.152897) | |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2025-06-30 |