| NPI | 1720428196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301113572) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2013018900) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301113572) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2026-02-18 |