| NPI | 1881398865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 2024-02749) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC RTL24-0243) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2025-09-04 |