| NPI | 1962107110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 95-00089) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2025016278) | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-01-30 |