| NPI | 1770019408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA OP61181089) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO TL.0006552) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2021-10-01 |