| NPI | 1750570669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 095090) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 51718) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2019-02-14 |