| NPI | 1972180776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0074992) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS022804) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT020910) | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2025-06-23 |