| NPI | 1902149248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NV 16431) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: LA MD.207143) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: LA PGY.202293) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2022-03-17 |