| NPI | 1912393091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX S2876) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA 170602) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 72412-20) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IN 01084926A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2023-01-12 |