| NPI | 1710674452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R4105) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AZ 012644) |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2026-09-01 |