| NPI | 1013324136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R3432) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY R3432) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2020-12-10 |