| NPI | 1770996068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 274620) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: FL OS15190) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO3877) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2023-05-10 |