| NPI | 1750649455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 63230) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 56761) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 56761) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2018-11-19 |