| NPI | 1801057955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S6562) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 64048) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 28445) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S6562) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2022-08-16 |