| NPI | 1902331747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U7362) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-14546) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 29554) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 63591) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35C.003139) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301504406) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2026-04-27 |