| NPI | 1972531226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 39314) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: ND 10814) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 10814) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-06-04 |