| NPI | 1730446204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 60083) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ND 13368) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2016-10-01 |