| NPI | 1952718652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A161599) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 55454) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 51451) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R3600) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2022-12-07 |