| NPI | 1942432414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301103765) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 54265) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2025-12-30 |