| NPI | 1992264220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA OP61324838) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61210477) |
| 208D00000X General Practice (Licence: WA 61324838) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2023-03-08 |