| NPI | 1811516289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 36043) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 36043) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 36043) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2023-07-20 |