| NPI | 1962963785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS19880) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2023040078) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2024-04-18 |