| NPI | 1710447255 |
|---|---|
| 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: MO 2023025341) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 94-09805) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2023-07-06 |