| NPI | 1013238229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0013160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042.0013160) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT196684) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2022-08-19 |