| NPI | 1730541426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-44798) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-44798) |
| 207R00000X Internal Medicine (Licence: MO 2021029426) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2021029426) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2021-08-12 |