| NPI | 1770872160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2018-02647) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q3309) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 172798) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2025-10-21 |